KETAMINE COMBINED WITH DEXTROMETHORPHAN-BUPROPION FOR DEPRESSION IN THE CONTEXT OF NITROUS OXIDE MISUSE
Sagar Sanjeev Dua, Yasmine Busaibe, Eric Wang, Tornike Phagava, Rithika Narravula, Parinda Parikh
International Journal of Advanced Research October 31, 2025 DOI: 10.21474/ijar01/21904 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Case report Peer reviewed |
|---|---|
| Sample size | 1 |
| Population | A 27-year-old male with no prior psychiatric history presenting with escalating nitrous oxide use after a cousin's suicide |
| Interventions | Ketamine infusion dextromethorphan-bupropion (Auvelity) naltrexone |
| Duration | Two-week follow-up |
| Topics | Depression Ketamine Esketamine |
| Keywords | Naltrexone Context archaeology Nitrous oxide Depression economics Antidepressant Nmda receptor Abstinence Clinical trial Intensive care medicine Anesthesia Craving Recreational drug Electroconvulsive therapy studies |
| Key findings | Combination of ketamine infusion, dextromethorphan-bupropion, and naltrexone led to abstinence from nitrous oxide and symptom improvement in a patient with treatment-resistant depression and compulsive nitrous oxide use. |
Abstract
Background: Treatment-resistant depression (TRD) affects up to a third of patients with major depressive disorder and remains difficult to manage with conventional therapies. Rapid-acting antidepressants targeting the glutamatergic system, such as ketamine, esketamine, and dextromethorphan-bupropion, have emerged as promising alternatives. Nitrous oxide, also an NMDA receptor antagonist, has demonstrated antidepressant properties in clinical trials but carries significant risks when used recreationally. Case Presentation: We describe a 27-year-old male with no prior psychiatric history who presented with escalating nitrous oxide use following the suicide of his cousin. He reported compulsive urges to continue use despite associated psychiatric symptoms. The patient endorsed depressive features without suicidal intent or psychosis. Given the limited two-week timeframe prior to his wedding, rapid-acting treatment was initiated with ketamine infusion and dextromethorphan-bupropion (Auvelity), along with naltrexone for craving management. At two-week follow-up, the patient reported abstinence from nitrous oxide, reduced irritability, and symptomatic improvement.
Discussion: This case underscores the clinical overlap between recreational nitrous oxide use and emerging therapeutic applications of NMDA receptor antagonists. Ketamine provided rapid symptom reduction, while dextromethorphan-bupropion supported early maintenance of response. The combination highlights a potential therapeutic pathway for patients who self medicate with nitrous oxide, substituting maladaptive use with evidence-based, clinically supervised interventions.